Provider Demographics
NPI:1629355052
Name:G AND T COLLABORATIVE
Entity Type:Organization
Organization Name:G AND T COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WHITE-SMILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LSWA
Authorized Official - Phone:202-271-1091
Mailing Address - Street 1:312 PEABODY ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2119
Mailing Address - Country:US
Mailing Address - Phone:202-271-1091
Mailing Address - Fax:
Practice Address - Street 1:312 PEABODY ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2119
Practice Address - Country:US
Practice Address - Phone:202-271-1091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty